Top

Published in:

Open Access 01-01-2020 | Kidney Transplantation | Nuclear Medicine

Limited clinical value of two consecutive post-transplant renal scintigraphy procedures

Authors: Stan Benjamens, Robert A. Pol, Stefan P. Berger, Andor W. J. M. Glaudemans, Petra Dibbets-Schneider, Riemer H. J. A. Slart, Lioe-Fee de Geus-Oei

Published in: European Radiology | Issue 1/2020

Abstract

Objectives

Duration of delayed graft function (DGF) and length of hospital stay (LOS) are outcomes of interest in an era that warrants increased efficacy of transplant care whereas renal allografts originate increasingly from marginal donors. While earlier studies investigate the predictive capability of a single renal scintigraphy, this study focuses on the value for both DGF duration and LOS of consecutively performed scintigraphies.

Methods

From 2011 to 2014, renal transplant recipients referred for a Tc-99m MAG3 renal scintigraphy were included in a single-center retrospective study. Primary endpoints were DGF duration and LOS. Both the first (≤ 3 days) and second scintigraphies (3–7 days after transplantation) were analyzed using a 4-grade qualitative scale and quantitative indices (TFS, cTER, MUC10, average upslope).

Results

We evaluated 200 first and 108 (54%) consecutively performed scintigraphies. The Kaplan-Meier curves for DGF duration and qualitative grading of the first and second scintigraphy showed significant differences between the grades (p < 0.01). The Kaplan-Meier curve for the delta grades between these procedures (lower, equal, or higher grade) did not show significant differences (p = 0.18). Multivariate analysis showed a significant association between the qualitative grades, from the first and second scintigraphy, and DGF duration, HR 1.8 (1.4–2.2, p < 0.01) and 2.8 (1.8–4.3, p < 0.01), respectively.

Conclusions

Qualitative grades of single renal scintigraphies, performed within 7 days after transplantation, can be used to make a reliable image-guided decision on the need for dialysis and to predict LOS. A consecutive renal scintigraphy, however, did not show an additional value in the assessment of DGF.

Key Points

• Post-transplant renal scintigraphy procedures provide information to predict delayed graft function duration and length of hospital stay.

• Performing two consecutive renal scintigraphy procedures within 1 week after transplantation does not strengthen the prediction of delayed graft function duration and length of hospital stay.

• Single renal scintigraphy procedures can be used to provide clinicians and patients with a reliable indication of the need for dialysis after transplantation and the expected duration of hospitalization.

Available only for authorised users

Perico N, Cattaneo D, Sayegh MH, Remuzzi G (2004) Delayed graft function in kidney transplantation. Lancet. 364(9447):1814–1827CrossRefPubMed

Gill J, Dong J, Rose C, Gill JS (2016) The risk of allograft failure and the survival benefit of kidney transplantation are complicated by delayed graft function. Kidney Int 89:1331–1336CrossRefPubMed

Wu WK, Famure O, Li Y, Kim SJ (2015) Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation. Kidney Int 88(10):851–858CrossRefPubMed

Saidi RF, Elias N, Kawai T et al (2007) Outcome of kidney transplantation using expanded criteria donors and donation after cardiac death kidneys: realities and costs. Am J Transplant 7(12):2769–2774CrossRefPubMed

Englesbe MJ, Ads Y, Cohn JA et al (2008) The effects of donor and recipient practices on transplant center finances. Am J Transplant 8(3):586–592CrossRefPubMed

Machnicki G, Lentine KL, Salvalaggio PR, Burroughs TE, Brennan DC, Schnitzler MA (2011) Kidney transplant Medicare payments and length of stay: associations with comorbidities and organ quality. Arch Med Sci 7(2):278–286CrossRefPubMedPubMedCentral

Bank JR, Ruhaak R, Soonawala D et al (2019) Urinary TIMP-2 predicts the presence and duration of delayed graft function in donation after circulatory death kidney transplant recipients. Transplantation. https://doi.org/10.1097/TP.0000000000002472

Hollmen ME, Kyllönen LE, Inkinen KA, Lalla ML, Salmela KT (2011) Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation. Kidney Int 79(1):89–98CrossRefPubMed

Yazici B, Gunay E, Akgün A, Sen S, Ozbek SS (2018) Scintigraphic and sonographic findings of subcapsular cortical necrosis in a transplanted kidney. Clin Nucl Med 43(7):542–545CrossRefPubMed

10.

Yazici B, Oral A, Akgün A (2018) Contribution of SPECT/CT to evaluate urinary leakage suspicion in renal transplant patients. Clin Nucl Med 43(10):e378–e380CrossRefPubMed

11.

Benjamens S, Berger SP, Glaudemans AWJM, Sanders JSF, Pol RA, Slart RHJA (2018) Renal scintigraphy for post-transplant monitoring after kidney transplantation. Transplant Rev (Orlando) 32(2):102–109CrossRef

12.

Heaf JG, Iversen J (2000) Uses and limitations of renal scintigraphy in renal transplantation monitoring. Eur J Nucl Med 27(7):871–879CrossRefPubMed

13.

El-Maghraby TA, Boom H, Camps JA et al (2002) Delayed graft function is characterized by reduced functional mass measured by (99m)Technetium-mercaptoacetyltriglycine renography. Transplantation. 74(2):203–208CrossRefPubMed

14.

Yazici B (2018) Practical method for calculation of graft index in renal transplant scintigraphy: a technical note. Clin Nucl Med 44(1):33–37

15.

Yazici B, Yazici A, Oral A, Akgün A, Toz H (2013) Comparison of renal transplant scintigraphy with renal resistance index for prediction of early graft dysfunction and evaluation of acute tubular necrosis and acute rejection. Clin Nucl Med 38(12):931–935CrossRefPubMed

16.

Yazici B, Oral A, Gokalp C et al (2015) Evaluation of renal transplant scintigraphy and resistance index performed within 2 days after transplantation in predicting long-term graft function. Clin Nucl Med 40(7):548–552CrossRefPubMed

17.

Majima T, Hattori R, Funahashi Y et al (2012) 99mTc-mercaptoacetyl triglycine renography to monitor renal transplant function among kidneys from donors after cardiac death. Transplant Proc 44(1):49–53CrossRefPubMed

18.

Obeidat MA, Luyckx VA, Grebe SO et al (2011) Post-transplant nuclear renal scans correlate with renal injury biomarkers and early allograft outcomes. Nephrol Dial Transplant 26(9):3038–3045CrossRefPubMed

19.

Stevens H, de Klerk JM, Mertens IJ, van Rijk PP, Hené RJ (2001) Quantitative baseline renography 48 hours after renal transplantation predicts long-term graft survival. Eur J Nucl Med 28(11):1677–1681

20.

Yazici B, Oral A, Gokalp C, Akgün A, Toz H, Hoscoskun C (2016) A new quantitative index for baseline renal transplant scintigraphy with 99mTc-DTPA in evaluation of delayed graft function and prediction of 1-year graft function. Clin Nucl Med 41(3):182–188CrossRefPubMed

21.

Benjamens S, Pol RA, de Geus-Oei LF et al (2018) Can transplant renal scintigraphy predict the duration of delayed graft function? A dual center retrospective study. PLoS One 13(3):e0193791CrossRefPubMedPubMedCentral

22.

Yarlagadda SG, Coca SG, Garg AX et al (2008) Marked variation in the definition and diagnosis of delayed graft function: a systematic review. Nephrol Dial Transplant 23(9):2995–3003CrossRefPubMedPubMedCentral

23.

Loupy A, Haas M, Solez K et al (2017) The Banff 2015 kidney meeting report: current challenges in rejection classification and prospects for adopting molecular pathology. Am J Transplant 17(1):28–41CrossRefPubMed

24.

Guignard R, Mourad G, Mariano-Goulart D (2011) Utility of postsurgical renal scintigraphy to predict one-year outcome of renal transplants in patients with delayed graft function. Nucl Med Commun 32(4):314CrossRefPubMed

Title: Limited clinical value of two consecutive post-transplant renal scintigraphy procedures
Authors: Stan Benjamens
Robert A. Pol
Stefan P. Berger
Andor W. J. M. Glaudemans
Petra Dibbets-Schneider
Riemer H. J. A. Slart
Lioe-Fee de Geus-Oei
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Scintigraphy
Kidney Transplantation
Published in: European Radiology / Issue 1/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06334-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Limited clinical value of two consecutive post-transplant renal scintigraphy procedures

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 1/2020

Interobserver agreement of whole-body magnetic resonance imaging is superior to whole-body computed tomography for assessing disease burden in patients with multiple myeloma

Radiomic feature reproducibility in contrast-enhanced CT of the pancreas is affected by variabilities in scan parameters and manual segmentation

Peritumoral ADC values in breast cancer: region of interest selection, associations with hyaluronan intensity, and prognostic significance

Application of the newest European Association of Cardiovascular Imaging Recommendation regarding the long-term prognostic relevance of left ventricular diastolic function in heart failure with preserved ejection fraction

Dose reduction and image quality improvement of chest radiography by using bone-suppression technique and low tube voltage: a phantom study

CT iterative reconstruction algorithms: a task-based image quality assessment